Personalized by Design / A1Wrappers-USA                           Faxable Candy Bar ORDER FORM
(800) 945-5522                Fax:  (973) 728-7043                   (Please PRINT all information)
Quantity: ______ Design #:______
Occasion: ______________________
Name on Bar: ______________________
Party Date: ______________________
Colors: ______________________
Theme*: ______________________
Wrappers Only: [ ] Wrapper w/ Chocolate: [ ]
Paper Color 
& Type:
GLOSSY: MATTE:
[ ]White
[ ]Silver
[ ]Gold		 [ ]Pink 
[ ]Blue 
[ ]Green
[ ]Teal 
[ ]Yellow
[ ]Peach
[ ]Goldenrod
[ ]Lavender
[ ]Ivory
[ ] Light Gray
*Sorry We cannot use Licensed Characters		  Draw or Describe FRONT & Back: 
 
 
 
 
 
 
 
 

 ___________________________________________________

(Not Actual size) (Space is limited-some info may have to be modified)  (Use separate paper if not using Special Facts Back)
 
Credit Card billing address (if different than Ship To)
Ship to: ________________________________ Sold to: ________________________________
_______________________ Apt:_____ ________________________ Apt:_____
________________________________ ________________________________
Ship Via Ground [  ] (3-7 day)   Second Day [  ](3-4 day) Express [  ] (1-3 day) 
RUSH (24 Hour process) $15.00 [ ]    (48 Hour process) $10.00 [ ]
Transit time depends on time, day of receipt of order as well as completion of order. 
Shipping Charges are based on Quantity and Zone. We do not inflate shipping charges.
Is this a gift?   Yes [ ]    No [ ] GIFT WRAP [  ] (includes small enclosure card)     5x7 GIFT CARD  [  ]
Note for Enclosure card/Gift Card:  ___________________________________________________________
We will confirm order and give you total BEFORE your card is charged.
Payment:
Visa/MasterCard/Discover:		 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp. Date: ________
  X__________________________________________________________     Card Holder Phone: ______________________
     Authorized Signature
Checks and Money Orders also gladly accepted.      Allow 2 weeks clear time for checks
 
Mail completed form to: Personalized by Design
1141 Greenwood Lake Tpk.  -  Ringwood, NJ 07456		 or   Fax to:  (973) 728-7043
Click to return to the www.personalizedbydesign.com